丙泊酚持续静脉输注治疗外伤性颅脑损伤患者手术后脑水肿疗效观察  

Study on the protecting effect of propofol continuous intravenous therapy on cerebral edema after traumatic craniocerebral injury surgery

作　　者：丁忠阳[1] 张家明[1] 黄国荣[1] 季冬东[1] 

机构地区：[1]南京医科大学附属无锡市人民医院急诊中心,江苏无锡214023

出　　处：《临床和实验医学杂志》2014年第22期1841-1844,共4页Journal of Clinical and Experimental Medicine

基　　金：江苏省卫生厅课题(编号:Z201311)

摘　　要：目的探讨丙泊酚持续静脉输注治疗外伤性颅脑损伤患者手术后脑水肿的临床疗效。方法将2012年1月至2013年12月急诊入院的外伤性颅脑损伤患者68例随机分为对照组与观察组,每组各34例。两组患者均行急诊开颅手术治疗后,对照组给予术后常规脱水降低颅内压、止血、抗感染、营养神经及其他对症支持治疗;观察组在对照组治疗用药的基础上,于手术后第1天即开始接受丙泊酚持续静脉输注治疗。先给予丙泊酚1.5 mg·kg^-1静推作为镇静诱导,再对患者进行持续静脉输注0.3-0.4 mg·kg^-1·h^-1,用药时间至少持续到手术后第3天。使用CT检查术后患者脑水肿的动态变化情况,并监测患者颅内压（ICP）变化,术后6个月随访,使用MMSE评分量表对两组患者进行评分。结果观察组患者手术后第3-4天及第7-8天脑水肿量较对照组有明显减少（P〈0.01）;术后第1天、第4天、第7天、第10天观察组ICP均显著低于对照组（P〈0.01）;术后6个月观察组患者MMSE评分较对照组有所增高,但差异无统计学意义（P〉0.05）。结论丙泊酚静脉持续输注可有效减轻外伤性颅脑损伤患者手术后脑水肿的程度,降低颅内压,从而提高外伤性颅脑损伤手术的疗效。Objective To explore the clinical efficacy of propofol continuous intravenous therapy on cerebral edema after surgery on traumatic craniocerebral injury. Methods A total of 68 patients with traumatic craniocerebral injury in this hospital during January 2012 to December2013 were collected and randomly divided into observation group and control group,34 patients in each group. Patients in both groups received emergency operation for treatment. After operation,patients in control group were treated with conventional dehydration in order to reduce the intracranial pressure（ ICP）,stopping bleeding,anti- infection,nutritional supply and other support therapy; patients in observation group received propofol continuous intravenous therapy on the first day after surgery on the basis of treatment in control group. Propofol 1. 5 mg·kg^-1 intravenous injection was used for calm inducement,and then,propofol 0. 3 - 0. 4 mg·kg^-1·h^-1 continuous venous infusion was continued for at least 3days after operation. The postoperative dynamic changes of cerebral edema in patients were examined by CT scanning,and changes in ICP were also monitored. MMSE scores were estimated and recorded in follow- up period for six months after surgery. Results Volume of cerebral edema in3 to 4 days and 7 to 8 days after operation in patients of observation group had been significantly reduced compared with that of patients in control group（ P〈0. 01）. At 1 day,4 days,7 days and 10 days after surgery,ICP of patients in observation group was significantly lower than that of control group（ P〈0. 01）. The difference in MMSE scores between two groups was not significant in follow- up period for six months after surgery（ P〉0. 05）,although it was higher in observation group than that of control group. Conclusion Propofol continuous intravenous therapy can reduce the degree of cerebral edema and ICP after operation for traumatic craniocerebral injury,and thereby it can improve the clinical effect of operation for traumatic craniocereb

关 键 词：外伤性颅脑损伤 丙泊酚 持续静脉输注 脑水肿 颅内压(ICP) MMSE评分 

分 类 号：R651.15[医药卫生—外科学]